DaVinci Data Exchange for Quality Measures DEQM Universal Realm (PSS-2691)

Note that this is a new JIRA PSS to the existing project, PI ID 1429.

The purpose of this change is to create a Universal Realm successor to the DEQM STU 5 IG already published in the US Realm.

DEQM STU 5.0.0 is published in the US Realm, and this PSS will result in a new IG in the Universal Realm that does not create a new product page. The product page will be updated to describe it as the international successor standard to the US Realm IG.

As part of the move to Universal Realm, any language and dependencies regarding US Realm IGs will be removed and/or generalized. In addition, we will secure support of at least 2 international implementers for the project, and it is already known to be in use in the international space.

The below information is a modified version of the original DEQM PSS that reflects the STU 5 publication and the intent of the proposed UV Realm version.

Description of the proposed FHIR IG

• Scope: to address the general case of requesting/exchanging information for quality measures, the evaluation of quality measures, and the submission of measure reports and any associated FHIR resources.
• Develop general use case for one or more measures where an aggregator is the requestor and/or recipient of measure reports on one or more patients. Note: Aggregator may be part of EHR, Payer system or a standalone service
• Aggregator will exchange information with the Provider’s EHR or other provider service as a pull or push operation (recommendations/options/requirements as part of IG development)
• Exchange with provider system may have more than one FHIR content set depending on the requirements of the specific use case and HIT technology (scope determined as part of IG development)
• The Argonaut project FHIR Bulk Submit will be used as a basis for bulk submission of data

Description of the included Gaps in Care functionality

• Scope: to address the general case of requesting/exchanging specific (patient and population level) detailed information for gaps in care.
• Define the following:
• scope of a “gap in care”
• key stakeholders
• the technical process for defining the open, closed, and potential gaps in care for a single patient or population of patients
• the FHIR payload to represent this list of patients/population and their gaps in care, including the status of the gap in care
• the FHIR interactions to support the query and response of this list
• the process of reporting the resolution of a gap in care back to a reporting stakeholder (e.g. payers), aligned with the framework established in the rest of the DEQM IG. This addresses both the closure of gap as well as exceptions.
• Out of scope for gaps in care functionality
• How the provider organization utilize the Gaps in Care information once it’s received via FHIR
• Hierarchical Condition Category documentation for risk adjustment, also referred to as “gaps in coding.”